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ABSTRACT
Aim: To determine the value of the blink reflex in evaluating trigeminal sensory function during microvascular decompression for trigeminal neuralgia.
Methods: The blink reflex (BR) in 103 patients with primary typical trigeminal neuralgia treated by microvascular decompression (MVD) was tested pre- and intraoperatively. The changes in BR were recorded. All patients underwent general anesthesia with intravenous propofol and fentanyl. Surgical efficacy and complications were evaluated after surgery. The relationship between intraoperative changes in the BR and postoperative trigeminal sensory function was analyzed.
Results: The BR was elicited in all patients before surgery, and no significant difference was found between the affected side and the contralateral side. In 93 of the 103 cases, the BR was successfully elicited during MVD surgery. Therefore, the recordability of the BR was 90.29%. R1 latency on the affected side and the contralateral side were 11.62 ± 4.96 ms and 11.66 ± 4.37 ms, respectively. During MVD surgery, R1 of the BR disappeared on the affected side in 7 cases and remained in 86 cases. After the operation, 98 of the 103 patients had immediate and complete remission of trigeminal neuralgia symptoms, and 5 cases had partial remission. The 7 patients whose R1 disappeared during the surgery all experienced facial numbness postoperatively. Of the 86 patients whose R1 remained, only 2 patients had postoperative facial numbness. Of the 10 patients whose R1 was not recordable during the operation, one complained of postoperative facial numbness. No patients had complications such as facial paralysis, cerebrospinal fluid leakage, and death.
Conclusions: Conclusion: The blink reflex may allow monitoring of trigeminal sensory function during microvascular decompression under general anesthesia.
Disclosure statement
No potential conflict of interest was reported by the authors.
Disclosure of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Notes on contributors
Tingting Ying
Tingting Ying: Specialized in intraoperative neurophysiological monitoring (IONM).
Bei Bao
Bei Bao: Specialized in medical treatment of cranial nerve diseases.
Yan Yuan
Yan Yuan: Specialized in intraoperative neurophysiological monitoring (IONM).
Wenxiang Zhong
Wenxiang Zhong: Specialized in intraoperative neurophysiological monitoring (IONM).
Jin Zhu
Jin Zhu:Specialized in diagnosis and treatment of cranial nerve diseases.
Yinda Tang
Yinda Tang: Specialized in diagnosis and treatment of cranial nerve diseases.
Shiting Li
Shiting Li: Director of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Chairman of World Federation of Cranial Nerve Disease Surgeons(WNFCND). Specialized in diagnosis and treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, blepharospasm, Major syndrome, and facial paralysis. He has also accumulated rich experience in the minimally invasive treatment of meningiomas, pituitary tumors, craniopharyngiomas, and schwannoma.